HomeMy WebLinkAboutMortgage_Kruse (2)STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (R11 / 6-09)
;+ prescribed by Department of Local Govemment Finance File Mark
INSTRUCTIONS: Form filed with:
To 6e filed in person or 6y mail with the CountyAuditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Property: Must file during the year for whieh the deduction is sought � County Auditor
2) Mo6ile / Manufactured Homes not assessed as Real Property: Must file during the tweive (12) months � County Recorder
6efore March 31 of each year the deduction is soughi.
See reverse side for additional instructions and qua/fications.
ApplicaM�ownerprcontractbuyer-,se�rest/ictions verseside)
Tapng Di ' Key number egal descrip6on � Record nu� Pag nu��/
�DO c�a 7�5 "Gb '
p� ,�Iue �� property es of Mort �� e! Contract indehtedness unpaid as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole
M� ��M yp,ar Marc.Fy�,�nt ar D date of application legal or equitaWe owneft
❑ Yes ❑ No
If no, what is his / her exact share qf interest? If owned with someone other than spouse, indipte with whom
If name on record is ditferent than that of applicani, indicate below:
Name of mor�qagee or contract selier
Address of mortgagee or contract seller (num6er and street, city, �state, and ZIP code)
Name of assignee or other owner or hdder of mortgage
Address of assignee (number and street, ciry, state, and ZIP coc
Does aPplicant own property in any other If yes, w
county in Indiana? � Yes ❑ No
DeducKion approved in the amount of:
20
Signature of County Auditor
20 � �
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D1-a�ver I�O• .. ..
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Cal�� � �;� � h6i�--�
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20 � 20
Counry
�Is property in question: Mnually Assessed
� property ❑ Annually Assessed
Y"' Mobile Home (IC 6-1.
this deduction been requested on property
irrent year? � Y� ❑ No
20
Date (month, day, yea�
20
I! We certify under the penaity of perjury that the above and foregoing infortnation is Vue and correct and that the applicant is a resident of Indiana and
owner ! contrad buyer of the aforementioned property on date appiication is filed.
Signature s fuli n ) � Date (month, day, year�
Full re' ent address of a Iicant (number anf stieet, cily, state, and ZIP ooale)
authorized by duly executed Power of Attomey or by IC 6-1.1-12-0.7
Address of author¢ed person (number and sUeet city, state, and ZIP code)
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Date (monfh, day, yea�